Corporate Compliance

Note: Critical access hospitals and billing for non-patient laboratory testing

Medicare Insider, July 21, 2009

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Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the author of this week’s note from the instructor.

In a May 12 post, clarification was given regarding a “non-patient” and reference laboratory testing.  Continuing with this discussion, Critical access hospitals (CAH) also received good news in Transmittal 1729 to the Claims Processing Manual, dated May 8, 2009.  Under Section 148 of MIPPA (Medicare Improvements for Patients and Providers Act), a CAH will be paid 101% of reasonable cost for outpatient clinical diagnostic laboratory tests for those patients who are not physically present in the CAH at the time the specimen is collected.  These patients are referred to as “non-patients” since only a specimen is received for the date of service.  Prior to this transmittal, all hospitals providing laboratory services to “non-patients” were instructed to bill on Type of Bill (TOB) 14X which triggered reimbursement under the Clinical Laboratory Fee Schedule.

To read more, click over to the MedicareMentor Blog.

In addition, Kimberly Hoy has posted a response regarding condition code 44 and observation services.

 



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